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DOI: 10.1055/s-0030-1269103
Impact of bilateral internal thoracic artery in situ vs. T-graft on outcome in coronary surgery
Objectives: Several studies have shown a clear benefit of bilateral internal thoracic artery (BITA) grafting over single-ITA. However, the impact of the revascularisation strategy on outcome is still not known. We compared coronary artery bypass grafting (CABG) with BITA in situ and BITA as T-graft regarding perioperative data, quality- of-life (QOL) and mid-term postoperative follow-up.
Methods: 348 patients [Age: 63±9 y; 85% male] underwent BITA revascularisation, 240 receiving received BITA in situ (69%) and 108 BITA as T-graft (31%). Risk factors and operative data, including use and time of cardiopulmonary bypass (CPB), number of grafts, and use of jump-grafts were analyzed. Postoperative complications, and need for reoperation/intervention were assessed. A modified SF-36 QOL assessment tool was completed at follow-up [85% Patients; mean 36 months].
Results: There were no significant differences within the groups regarding preoperative risk factors, as diabetes, smoking, and familiar disposition. T-graft patients received significant less grafts than in situ patients [2.8 vs. 3.1] by comparable coronary status. More patients with a T-graft underwent an off-pump-CABG. Total x-clamp and CPB-time were longer in the T-Graft than in the BITA in situ patients. The 30-day survival within the groups was comparable [in situ 98.3% vs. T-graft 99.2%]. Postoperative analysis did not show differences regarding postoperative complications within the groups. At follow-up, both collectives showed a similar rate of re-intervention [in situ 7.5% vs. T-graft 7.4%], QOL and survival.
Conclusions: BITA in situ and BITA as T-graft are comparable techniques for CABG regarding 30-day survival, mid-term outcome, freedom from re-intervention and QOL.